SENIOR INPATIENT CODER

The Senior Inpatient Coder is responsible for addressing appeals to insurance companies and coding highly complex medical records using the current International Classification of Diseases (ICD10 CM/PCS codes) and entering coded information into an automated grouper system. Technical guidance and acting in a lead role is expected.  Does related work as required.

Responsibilities:

• Addresses appeals to insurance denials to facilitate expedient resolution and reimbursement.
• Interprets and applies American Hospital Association Official Coding guidelines to articulate and support principle and secondary diagnoses and selected procedures.
• Identifies and analyzes patterns in possible coding errors or other trends and reports to the the coding leadership team.
• Participates in mandated medical record review processes.
• Using current ICD10 CM/PCS coding systems, assigns and records an accurate code to all diagnoses, procedures, and operations as documented by the attending physician in the indicated patient's medical record.
• Queries physicians for documentation clarification
• Ensures that all factors necessary for assigning an accurate DRG are present, and that all diagnoses are ranked properly.
• Makes appropriate contacts in order to acquire or clarify necessary information.
• Compiles and updates the appeal log detailing denials, hospital's reply, and follow-up responses.
• Provides information and responds to inquiries regarding medical documentation and DRG'S to hospital staff including Utilization and Quality Assurance staff, Patient Accounts staff and the Risk Manager.
• Abstracts information from medical records to compile reports and statistical information.
• May train lower level coders and provide technical guidance and expertise
• Resolves bill holds in a timely manner to maintain DNFB and maintains coding queue
• Acts as a liason between Patient Accounting and Coding

Qualifications/Requirements:

Experience:

• Minimum of  three years of experience where the primary function of the position must have been inpatient coding in acute care setting.

Demonstrate proficiency

• in ICD 10 CM and ICD 10 PCS by passing coding assessment administered before hire.   

Education:  

• High School or equivalency diploma, required.  Satisfactory completion of 30 credits* toward an Associate’s degree or Bachelor’s degree in health information management may be substituted on a year for year basis for up to four years of the general coding experience.  There is no substitution for the two years of specialized experience.

Licenses / Certifications:  

• Current certification as a Certified Coding Specialist (CCS) required.  Certification as Registered Health Information Administrator (RHIA) or as a Registered Health Information Technologist (RHIT) by the American Health Information Management Association preferred.

Other: 

• Comprehensive knowledge of the American Hospital Association (AHA) Official Coding Guidelines; comprehensive knowledge of the current and ICD10 CM/PCS codes; thorough knowledge of DRG classification systems; thorough knowledge of medical terminology, anatomy and physicology; ability to understand and code medical records; ability to communicate effectively both verbally and in writing; ability to effectively use computer applications or other automated systems such as spreadsheets, word processing, calendar and e-mail for performing work assignments; ability to read, write, speak, understand, and communicate sufficiently to perform the essential duties of the position.